How does the charting and claiming process differ for MoH High Caries?
Most normal processes can be followed if charting for OHSA/HC, but a few additional steps must be followed.
Prior approval is required. In addition to creating prior approval normally, once you have generated the standard HP5958 using the steps above, you must also manually fill out HP6656, manually attach it and submit it alongside this.
Charting must include a CON5 treatment code. If you attempt to carry out a High Caries treatment without charting CON5, the system will not know it is a High Caries and will not generate the ITR/claim summary automatically.
Normally when completing OHSA and SDS treatment plans, we generate an Individual Treatment Report (ITR) and add the plan to the claim management tool, where you then create a claim summary separately. For High Caries, the ITR and claim summary are combined, so you do not need to generate it separately.
It will already have 'Ready to submit' status, and the linked ITR document will be visible.
The claim summary cannot be deleted, as it is combined with the ITR - but you can reopen it.
Reopening the treatment plan differs slightly from the normal workflow - you can reopen when the status is 'Ready to submit'.